School of Public Health

PhD

Uganda

Empowering women in the context of poverty and HIV: the role of parenting self-efficacy in promoting child cognitive development

Many Ugandan women are burdened with caring both for their own children and for others orphaned by the HIV epidemic. Challenges associated with caregiving in an HIV-affected low resource context have negative implications for women’s wellbeing, child health, and if left unaddressed may ultimately contribute to a cycle of poverty. Parenting self-efficacy is a person’s belief in their parenting abilities and is considered a mechanism for personal empowerment. Low parenting self-efficacy is associated with negative parenting behaviors that put children at risk of poor cognitive and behavioral development, particularly in the context of poverty and HIV where the risk is already high. Although women’s empowerment programs are common globally, the individual, social, and cultural understandings of caregiver empowerment and self-efficacy have rarely been explored. Drawing on what is known about the context of complex adversity in which Ugandan HIV-affected women and children live, this project aims to examine caregiver empowerment and self-efficacy to add to a developing model of how these constructs are related to child cognitive and behavioral development. Working within an existing study of Ugandan caregivers and their HIV-exposed children, the applicant will explore women’s experiences, social, and cultural perceptions of empowerment and self-efficacy through key-informant interviews and focus groups. These findings will provide a framework for future quantitative analysis of data from caregiver-child dyads who participated in the larger study. This project seeks to inform the development and use of empowerment programs and the development of future maternal and child health promotion interventions in Uganda and in other low-resource settings.

After months of anticipation, I was really excited upon my arrival in Tororo, Uganda. I was working with an NGO at Tororo District Hospital to carry out a qualitative study with HIV-affected caregivers of young children. Tororo district is located in eastern Uganda close to the border with Kenya. The scenery in this region of the country is beautiful. Rolling hills dot the landscape around Tororo and much of the terrain is covered in lush greenery. On the trip from Kampala to Tororo the road passes through Jinja which boasts breathtaking views of the majestic Nile river. Once past Jinja, travelers frequently stop for warm Gonja (grilled plantain) to enjoy on the road while looking out at tea and sugarcane plantations along the way. Just before reaching Tororo, families of baboons can be easily sighted on the road as it passes through a forested area on the outskirts of Tororo.

A significant amount of planning had gone into the trip in the months before I left the United States, including frequent Skype calls with the local team at the NGO where I was working to finalize details about the project. Although it seemed like I would be there for a long time, I already knew that carrying out my proposed research project within the timeframe of the trip would be a challenge and I was glad to have worked with the team to organize logistics ahead of time. Once I arrived at the site in Tororo, Uganda, I learned perhaps the most important lesson in global health, which is that things rarely go according to plan. Learning to be patient and flexible was critical to the success of the project and to maintaining strong ties with the local team.

Living and working in a developing country was challenging in several ways. From a management perspective, finding my place within the organizational structure at the project site took some time. As with any new position, it can be challenging to figure out how to be helpful and meet project goals without stepping on anyone’s toes, particularly in the context of a pressing timeline. I found it helpful to listen to my colleagues and to learn about the organizational culture at the specific site where I was working and within the larger NGO. I quickly realized that I had unintentionally gone in with my own ideas of how best to accomplish the task at hand and I quickly learned that adopting the existing practices and routines already in place or combining these into a modified strategy would be much more efficient. Learning cultural cues that would tell me when I was on the right track and when I wasn’t also took some time. The bureaucracy at the hospital and at the university with whom we were working was challenging to navigate, and would have been impossible if it had not been for the help and guidance of the local team leader. I also found that engaging in self-care throughout the trip took persistence and a concerted effort. I had to consciously stop work and make time for exercise, sleep, and Skype calls home. Sometimes this required some creativity, and sometimes this pushed me out of my comfort zone.

I am very grateful for the time I was able to spend in Tororo and for the lessons learned from this experience. I feel that I have grown both personally and professionally and I look forward to keeping in touch with my Ugandan colleagues and practicing the skills that I acquired as I continue forward in global mental health.

Qualitative research team Tororo, Uganda:

Completion of qualitative research methods training of local team members in Tororo, Uganda: